Somatic symptom disorder, illness anxiety disorder, and functional syndromes are characterized by burdensome preoccupation with somatic symptoms. Etiological models propose either increased ...interoceptive accuracy through hypervigilance to the body, or decreased and biased interoception through top-down predictions about sensory events. This systematic review and meta-analysis summarizes findings of 68 studies examining interoceptive accuracy and 8 studies examining response biases in clinical or non-clinical groups. Analyses yielded a medium population effect size for decreased interoceptive accuracy in functional syndromes, but no observable effect in somatic symptom disorder and illness anxiety disorder. The overall effect size was highly heterogeneous. Regarding response bias, there was a small significant effect in somatic symptom disorder and illness anxiety disorder. Our findings strengthen the notion of top-down factors that result in biased rather than accurate perception of body signals in somatic symptom disorder and illness anxiety disorder.
Individuals suffering from depression exhibit a higher rate of unintended pregnancies, which are associated with negative outcomes for both parents and children. Often, unintended pregnancies result ...from contraceptive mistakes. Here, we examine the relationship between depression and the consistency of contraceptive behavior, testing ambivalence as a possible mediator. The analyses were based on cross-sectional data from the second and third waves of the German Relationship and Family Panel Pairfam. A German-speaking sample without children (
N
= 190; 117 female, 73 male), who reported not attempting to conceive or become pregnant during the last 12 months, was analyzed in comparison with a propensity score matched sample. Ambivalence was operationalized as the difference between the ideal and realistic number of children in wave 2. Data from wave 3 were used to assess contraceptive behavior. Depressed mood in wave 2 and consistency of contraceptive behavior in wave 3 were negatively correlated. After including ambivalence in wave 2 as a mediator in the model, the direct path between depressed mood and consistency of contraceptive behavior remained significant, with no significant mediation found. For men only, we observed a significant negative association of ambivalence with the consistency of contraceptive behavior in the last 3 months. No significant relationship was found between depressed mood and ambivalence. We conclude that future research aiming to better understand the consistency of contraceptive behavior should incorporate measures of ambivalence.
Interoceptive sensitivity, particularly regarding heartbeat, has been suggested to play a pivotal role in the pathogenesis of anxiety and anxiety disorders. This review provides an overview of ...methods which are frequently used to assess heartbeat perception in clinical studies and summarizes presently available results referring to interoceptive sensitivity with respect to heartbeat in anxiety-related traits (anxiety sensitivity, state/trait anxiety), panic disorder and other anxiety disorders. In addition, recent neurobiological studies of neuronal activation correlates of heartbeat perception using positron emission tomography (PET), functional magnetic resonance imaging (fMRI) or electroencephalographic (EEG) techniques are presented. Finally, possible clinical and therapeutic implications (e.g., beta-blockers, biofeedback therapy, cognitive interventions and interoceptive exposure) of the effects of heartbeat perception on anxiety and the anxiety disorders and the potential use of interoceptive sensitivity as an intermediate phenotype of anxiety disorders in future neurobiological and genetic studies are discussed.
Abstract Background/objectives Current models of SAD assume that attentional processes play a pivotal role in the etiology and maintenance of social anxiety disorder. Social anxiety is supposedly ...associated with an attentional bias towards disorder related stimuli such as threatening faces. Using the facial dot probe task in socially anxious individuals has, however, revealed inconsistent findings. Methods The current systematic review aims at disentangling the heterogeneous findings using effect sizes across results by systematically taking into account potential moderating variables (stimulus type, stimulus duration, situational anxiety, disorder severity). Results Results provide some evidence that socially anxious individuals preferentially allocate their attention towards threat faces compared to non-anxious controls. This bias seems to depend on the type of reference stimulus, stimulus duration and clinical level of social anxiety. Avoidance of threat was neither found at early, nor at later stages of attentional processing. Limitations Importantly, the results have to be considered in the light of the only few studies available. Given the heterogeneity of results and some methodological restrictions of the studies included, the picture of attentional bias seems to be much less clear than suggested in the recent social anxiety literature. Conclusions Methodologically, combined measures of dot-probe and eye movement measures might be beneficial to detect overt attentional biases. Importantly, our results show that preferential processing of threat cues might guide early attentional processes in social anxiety, depending however on several contextual and situational factors. Clinically, patients with greater severity of SAD may be more prone to such an attentional bias, thus therapists should take this into account when planning behavioral experiments and exposure therapy.
•The (accurate) perception of bodily states and emotions is closely linked in theory.•People with high interoceptive accuracy are assumed to perceive emotions more intensely.•This association is ...partially proven by empirical studies with heterogeneous results.•The assessment of interoception remains a challenge.
Emotion theories emphasize the relevance of (predicted) bodily changes for the construction of one's own emotions and an extensive overlap of brain regions involved during emotion intensity perception and somatosensory processing. The ability to accurately perceive bodily changes and its impact on the perception of emotion intensity has been studied for at least 40 years. The results of previous studies were summarized in a meta-analysis to examine how closely interoceptive accuracy and emotion intensity are related. After a systematic literature search, 4036 studies were screened for eligibility. Only studies assessing adults from general population samples were considered. Samples recruited to examine mental disorders or neurological conditions were excluded. Thirty studies with a quantifiable measure for the relation of interoceptive accuracy and emotion intensity perception were included in the meta-analysis. Interoceptive accuracy was significantly related with emotion intensity perception, when emotions were experimentally induced (k= 22, r= 0.15). However, the relationship was only found when IAPS images (k= 9, r= 0.33) or facial expressions (k= 3, r= 0.24) were used for emotion induction. No significant relation was found in studies without emotion induction (k= 19, r = -0.007). There was considerable bias, varying dependent on bias assessment method, study protocol and examined risk of bias dimension. We discuss the impact of differences in study protocols, review the operationalization of interoceptive accuracy critically and derive directions for future research.
Deviations in interoception might contribute to the development and maintenance of mental disorders. The improvement of interoceptive accuracy (IA) is desirable but assessment and training methods ...remain controversial. For instance, it was assumed that performance increases in heartbeat counting paradigms after cardiac feedback were due to an improvement of knowledge with regard to heart rate rather than due to an actual improvement in IA.
Here, we examined effects of contingent cardiac feedback training, non-contingent cardiac feedback, mindfulness practice, and a waiting period with external attentional focus on IA. 100 healthy participants underwent a mental tracking paradigm before and after 20 min of training or waiting.
Results revealed a significant increase of IA in the contingent feedback condition (d = 1.21, p ≤ .001) and no significant changes after non-contingent feedback, mindfulness practice or waiting (d ≤ 0.37; p ≥ .06). Furthermore, IA increase was significantly higher after the contingent feedback training compared to all other conditions, including non-contingent feedback.
Future studies need to replicate these findings in clinical samples and examine time dependent effects.
The results provide evidence for the trainability of heartbeat perception. IA improvements may reduce the symptom burden in people suffering from mental disorders and psychophysiological conditions that have been linked to lower interoceptive accuracy such as depression, somatic symptom disorder, chronic pain, and functional somatic syndromes. Consequently, exploration of biofeedback training procedures shall be continued with the aim of identifying relevant mediators of beneficial effects and future implementation in clinical practice.
•Examination of cardiac feedback training to improve interoceptive accuracy (IA).•Large effect of true feedback (d = 1.21).•Small effect of false feedback (d = 0.37).•No effect of waiting or mindfulness practice.•Improvement due to increased IA and not due to knowledge with regard to heartrate.
Depression is one of the most common mental disorders and a leading cause of disability worldwide. In adults, depression is characterized by decreased vagal activity (vagally-mediated heart rate ...variability; vmHRV), while vmHRV is inversely correlated with depressive symptoms. In children/adolescents, a 2016 synthesis (4 studies, 259 individuals) found similarly decreased vmHRV in clinical depression, but no significant association between depressive symptoms and vmHRV (6 studies, 2625 individuals). Given the small number of studies previously considered for synthesis and the rapidly growing evidence base in this area, a meta-analytic update was warranted.
A previous review was updated by a systematic literature search to identify studies that (a) compared vmHRV in clinically depressed children/adolescents with non-depressed controls and (b) reported associations between vmHRV and depression severity.
The search update identified 5 additional studies for group comparison (k = 9 studies in total, n = 608 individuals in total) and 15 additional studies for correlational meta-analysis (k = 21 studies in total, n = 4224 individuals in total). Evidence was found for lower resting-state vmHRV in clinically depressed children/adolescents compared to healthy controls (SMD = −0.593, 95 % CI −1.1760; −0.0101, I2 = 90.92 %) but not for a significant association between vmHRV and depressive symptoms (r = −0.053, 95 % CI −0.118; 0.012, I2 = 65.77 %). Meta-regression revealed a significant association between depressive symptoms and vmHRV as a function of sex.
The samples considered are highly heterogeneous. Data on the longitudinal association between vmHRV and depression are currently lacking.
The present findings support the use of vmHRV as a biomarker for clinical depression in children/adolescents.
•Depression is linked with reduced vagally-mediated heart rate variability (vmHRV).•We updated our previous systematic review on this link in children and adolescents.•We found lower resting vmHRV in clinically depressed minors versus healthy controls.•The link between depressive symptom severity and vmHRV varies as a function of sex.•Clinical implications and suggestions for future research are provided.
Background and Objectives: Previous research suggests that rumination acts as a mediating mechanism in the association between depression and drinking motives, particularly drinking to cope, as well ...as negative alcohol-related consequences. In this study, we tested the connections between depressive symptoms, rumination, drinking motives, alcohol consumption, and alcohol-related problems in a clinically depressed population (N = 209). Methods: Structural equation modeling was used to test the models. Specifications were based on the results of a previously evaluated model in a sample of college students. Results: The complex model showed a significant positive association between depressive symptoms and rumination. Drinking motives (enhancement and coping) were linked to more negative alcohol-related consequences. In a simplified model, pronounced depressive symptoms were associated with both increased ruminative thinking and more negative alcohol-related problems. Rumination was connected with stronger drinking motives (combined in one general factor), which were again associated with alcohol consumption and alcohol-related problems. Limitations: The use of self-report measures to determine diagnostic validity. Conclusions: In a clinically depressed sample, depressive symptoms were linked to increased negative alcohol-related consequences. This association was partially explained by rumination and drinking motives. However, rumination was less relevant than previous studies suggested.
•Patients with somatoform disorders received a heartbeat perception training.•There were no overall differences between the training and a waiting control group.•The training increased interoceptive ...accuracy in somatoform patients with low health anxiety.•Reductions in symptom reports were observed after the interoceptive training.•The study suggests a link between low interoceptive accuracy and somatoform disorders.
Distortions in interoceptive accuracy have been linked to somatoform disorders. In line with cognitive theories of symptom formation in somatoform disorders, decreases in interoceptive accuracy have recently been observed to co-occur with more severe symptom reports. The current study tested the hypothesis that experimentally increasing interoceptive accuracy should decrease symptom severity in somatoform disorders. Twenty-nine patients with somatoform disorders were instructed in a newly developed heartbeat perception training procedure. Heartbeat perception, as a proxy for interoceptive accuracy, was assessed with a mental tracking task. Although there were no significant differences between the training group and a waiting control group (n=23) regarding increases in heartbeat perception, health anxiety served as a moderator and significant reductions in state symptom reports were observed after training. These findings suggest a relation between lower interoceptive accuracy and the perception of bodily symptoms in somatoform disorders.
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